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<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />This Letter of Agreement between our respective organizations outlines the reimbursement terms <br />and conditions whereby UNC Faculty Physicians (UNC FP) will provide services related to breast <br />and cervical cancer screening for patients as referred by the Orange County Health Department <br />(OCHD). This letter will cover services provided on dates of service between July 1, 2020 and June <br />30, 2021. UNC FP shall comply with State regulations and local medical standards. For these <br />services, UNC FP agrees to accept as payment in full reimbursement rates as outlined on the “North <br />Carolina Breast and Cervical Cancer Control Program 2020 Services Fee Schedule” (Fee Schedule) <br />attached hereto as Exhibit B. Hospital services, if any, are excluded from this agreement, as are any <br />services provided by UNC FP that are not listed on the Fee Schedule. UNC FP further agrees to <br />seek payment only from the OCHD and will not seek payment from individual patients for services <br />covered under this agreement. <br /> <br />OCHD and UNC FP agree that UNC FP is an independent contractor and shall not represent i tself <br />as an agent or employee of OCHD for any purpose in the performance of UNC FP’s duties under <br />this contract. <br /> <br />To the extent permitted by the NC Tort Claims Act, the UNC FP shall indemnify and hold harmless <br />the OCHD, its officials, agents, and employees from and against all claims, damages, losses, and <br />expenses, (including but not limited to fees and charges of attorneys and other professionals and <br />costs related to court action or arbitration) arising out of or resulting from the performance of this <br />agreement or the actions of the UNC FP or its officials, employees, or contractors under this <br />agreement. This indemnification shall survive the termination of this agreement. <br /> <br />UNC FP represents that it is in compliance with all applicable Federal, State, and local laws, <br />regulations or orders, as amended or supplemented. The implementation of this contract will be <br />carried out in strict compliance with all Federal, State, or local laws. If applicable, UNC FP shall <br />comply with HIPAA Privacy rules effective April 2003 and HIPAA Security regulations and <br />guidelines effective February 2005. <br /> <br />Either party may terminate this agreement by giving thirty (30) days written notice to the other <br />party. <br /> <br /> <br />OCHD will notify Elizabeth Bullard of patients being referred to UNC as part of this program. <br />Identification will occur preferably by email, or otherwise phone, to: <br />UNC Hospitals – Gynecology Oncology Clinic <br />Elizabeth Bullard <br /> P (984) 215-5888 <br /> F (984) 974-9039 <br /> Elizabeth.Bullard2@unchealth.unc.edu <br /> <br /> <br />Exhibit A <br />NC Breast and Cervical Cancer Program <br />DocuSign Envelope ID: FB8633A7-7427-4234-85C2-8B1508ED7177